Provider Demographics
NPI:1952494593
Name:MANSON, LESLEY M (PSY-D)
Entity Type:Individual
Prefix:DR
First Name:LESLEY
Middle Name:M
Last Name:MANSON
Suffix:
Gender:F
Credentials:PSY-D
Other - Prefix:DR
Other - First Name:LESLEY
Other - Middle Name:
Other - Last Name:SHAW
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD
Mailing Address - Street 1:2468 S MARBLE ST
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-7134
Mailing Address - Country:US
Mailing Address - Phone:602-369-3343
Mailing Address - Fax:
Practice Address - Street 1:550 N 3RD ST
Practice Address - Street 2:DBH PROGRAM
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-2154
Practice Address - Country:US
Practice Address - Phone:602-496-6790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY20454103TC1900X
AZ4586103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling